339: Tools For Being Present In Recovery

Chris Sandel: Hey! If you want access to the transcripts, the show notes, and the links talked about as part of this episode, you can head to www.seven-health.com/339.

Hey, everyone. Welcome back to another episode of Real Health Radio. I’m your host, Chris Sandel. I’m a nutritionist and a coach and an eating disorder expert, and I help clients to fully recover.

Before we get on with today’s show, I just have an announcement that I’m currently taking on new clients. If you are living with an eating disorder and you would like to fully recover, I would love to help. I know that the concept of full recovery can feel like this far-off, distant thing or like a fantasy, but I truly believe that anyone who wants to fully recovery can get there. It’s just about doing the things that are required to make that happen. So if you would like to reach a place of full recovery, I would love to help. You can send an email to info@seven-health.com and just put ‘coaching’ in the subject line, and I can send over the details.

00:01:10

Why being present is important in recovery

So, on with today’s show. What I wanted to look at today is tools for being present in recovery. I want to just start out by saying that being present and being in the moment, while it can often be talked about as this way of getting great relief and coming back into the body, for most people in recovery that is not how it feels. Being present can feel dangerous, it can feel unfamiliar, it can feel intolerable. It doesn’t feel like it’s often described, as this wonderful, Zen-like experience.

And despite that, it is really important as part of recovery, and it’s a big thing that I focus on with clients when working with them. I think what often happens for many people in eating disorder recovery or living with an eating disorder – and I would say this is true of the general population; you don’t even have to have an eating disorder – I think for so many people, they live in a place of future fear of what will happen. “What will happen to my body? Where is this thing going to end up?” They live in past loops, so replaying memories or conversations or things that have happened rather than being in the present moment.

In that way, the eating disorder then becomes the buffer. So if I’m having these thoughts about what may happen in the future or getting stuck in the past or about expectations or worries, I can then focus on the eating disorder and following those behaviours, and the eating disorder then becomes this tool for avoidance.

Really, one of the antidotes to this is presence. Presence means feeling the things that you’ve spent years avoiding, which could be hunger, could be grief, could be shame, could be desire, could be anger, could be physical sensations – the list goes on. And yes, as I said a moment ago, that isn’t necessarily pleasant. But it is really important as part of recovery.

So what I want to do as part of this episode is just talk about some different ways of being able to do this. When I’m working with clients, what we usually find is there’s a handful – maybe a handful is saying too much; maybe it’s one or two things that they use and they keep coming back to, because “That is the thing that really helps me to stay in the moment.” If there are multiple things that people can do, great, but you don’t have to have many things. And especially when you’re getting started, you don’t have to have many things. It’s finding one tool that I can keep coming back to dependably to get started so I can get some momentum with this.

00:03:56

Acceptance & commitment therapy principles

When I think about presence, there’s lots of different modalities that I lean on as part of the work that I do, but acceptance and commitment therapy is a really big one. If I think about acceptance and commitment therapy, there are six main principles as part of it.

The first is called cognitive defusion, and this is really about not getting connected to your thoughts, or being able to recognise that thoughts are just thoughts, and “Just because I had a thought, doesn’t necessarily mean that it’s true, that it’s a value of mine, that it’s important, that it says anything about who I am as a person. This is just a thought.” And recognising that “When there are thoughts that I get hooked by and I start to believe are true or I have to act on, then I get pulled in a certain direction, versus when I’m able to notice them and just observe them and see that they’re just thoughts, I can create that distance between them.”

The next piece is expansion and acceptance. As part of this, this means rather than resisting certain things that come up – resisting thoughts or resisting emotions or resisting sensations – it’s being able to create room for those things. So not trying to push it away, but being able to create space for those things.

The next is contact with the present moment, which is a lot of what we’re talking about today, although they are all interconnected as part of this. So as I said, rather than getting swept up by the future and what may happen or the past or different expectations or different thoughts, it’s “How do I come back to the present moment?”

And then the observing self. This is about noticing that there is this observer within us and that there is this non-judgmental observer within us that is able to just notice different experiences. So it’s not labelled as good or bad; it is just being able to notice that this thing has occurred. Very much the mindfulness way of thinking about things, of just being able to observe things. I think a lot of this also comes back to self-compassion with “Hey, I’m being able to notice what is going on. I’m not minimising this thing that’s going on, but I’m also not blowing it up to being this really big thing. It’s just I’m noticing what is actually occurring.”

Then the final two – the first four, they talk about this as being the mindfulness element of acceptance and commitment therapy, and then the final two are more about the action-taking piece. So the fifth one is values – understanding what are your values – and taking action in accordance with those values. So “I’m living in alignment with my values” as opposed to “Oh, these are just aspirational values, and actually, if you follow me around, I’m not living in alignment with these values.” So really using values for decision-making.

And then the final piece is committed action. So understanding all of this, how do I take action on it? That could be action connected to my values and doing something in alignment with my values; it could be action to notice, “Hey, I’m getting hooked by certain thoughts, and how do I take action to defuse from those thoughts?” It could be “How do I take action to create room for certain emotions or sensations?”

But all of these principles are very much connected to how you start to live in alignment with your values and to create a life that is adding to the quality of your experience.

With the real core part of acceptance and commitment therapy, it’s about psychological flexibility. It’s being able to have more scope, more range, more ability to deal with the ups and downs of life and all the challenges that it presents. And if I’m thinking about this from a ‘staying in the present moment’ perspective, it’s not about doing that perfectly. It’s not that you are 100% always in the present moment and “I’m never getting hooked by certain thoughts” or “I’m never having challenges with certain emotions.” It’s doing this to the best of your ability, and it’s really about choosing to stay with what matters even when it is hard.

So if I was to sum this up in a couple of ways, you can be willing to feel the discomfort without needing to fix it first. For many people, this is quite a radical thing, to be able to sit with discomfort and not be trying to do something to instantly remove it.

And also, especially if I think about this from a recovery standpoint, it’s to be feeling like I’m doing something wrong and still doing it. So I notice when I eat more, I feel like I’m doing something wrong. I notice when I’m taking a break from exercise, I feel like I’m doing something wrong. And yet I’m still going to do that even though those thoughts or feelings or sensations are arising.

With that as a little bit of a basis for this, let me go through some different tools that then you can be using as these things arise.

00:09:13

Sensory grounding

The first one is using sensory grounding, so noticing what is safe. There are different versions of doing this. One version is called 5-4-3-2-1. It means that what you do is you bring in your senses to the present moment. There could be a lot going on, there could be a lot coming up, but I use this process of “Can I name 5 things that I can see?” So I look around the room or I look at the area that I’m in and name 5 things that I can see. I then name 4 things that I can hear. I then name 3 things that I can touch. I then name 2 things that I can smell. I then name 1 thing that I can taste.

And obviously, you can do this in different numbers. There’s nothing magic about those numbers. If you’re outside and you’re sitting in the grass or you’re sitting in the woods or whatever it is, it might be “Hey, I can pick up lots of different things.” So that one might become higher in terms of the numbers. But really what we’re wanting to do is just engage with our senses with intention and to come back into the present moment by using what is around us to help us to be able to do that.

While doing it, it’s not that you’re trying to tell those certain thoughts to go away or to tell certain emotions to go away. There’s an ability to have that be there at the same time, and I can notice that I can put my attention towards these other things while that is going on.

And you can do this in other ways. You can start to use your senses with intention where, for example, you’re putting lotion on your arms or your hands, so you’re doing the rubbing motion of doing that. Even just doing that without lotion, just being very intentional about rubbing your hands together and noticing the sensation – both the sensation of the hand being touched and the sensation of the touching hand.

You can have a cup of tea, a cup of herbal tea, for example, and be really intentional about smelling that and having the hot cup in your hands and noticing those sensations. You can have a blanket on yourself and noticing the texture of that blanket, noticing the weight of that blanket.

Really just any ways that you can be bringing in the different senses to help you stay in the present moment. I think this is really important for many people in recovery because for so many people, they’ve really just been living by the neck up. The body is feared, the body is numbed. We want to come back into the body. Really, what this helps one do is it really builds trust back into the body when you’re doing it in this way, when you’re bringing in those small doses.

The thing I’ll add to this is it doesn’t have to feel good; it just has to be you notice what you’re feeling and being able to stay with that feeling. And this is why if you’re holding a cup of tea, you can bring that sensation to that thing as well. So I may be noticing that I’ve got a lot of bloating or a lot of pain in my legs or whatever it is, and I can notice those sensations and I can also notice the sensation of holding the cup of tea and smelling the cup of tea and just being able to be present with all those different sensations.

00:12:30

Defusion

The next one is using defusion. As I said at the top, defusion is one of the six principles, and it’s creating a gap between yourself and your thoughts. Really just reminding yourself that thoughts are just thoughts. Within acceptance and commitment therapy, there are lots of different techniques for doing this.

One of them is adding the phrase “I’m noticing I’m having the thought…” So if I’m having the thought, for example, that “If I eat this cookie, I’m going to gain X amount of weight”, it’s then adding the “I’m noticing my mind is generating the thought ‘if I eat the cookie, I’m going to gain X amount of weight’.” By adding in that sentence or that prefix of “I’m having the thought” or “I’m noticing my mind is having the thought”, it adds a little bit of a buffer to remind you that this is just a thought.

It can feel a little bit clunky at first, but the more it’s practised, the more you start to remember this is just a thought. And the more you do it, you can get to the point where just saying the phrase “I’m noticing my mind is generating” – you don’t even have to add the extra bit in – that is almost a simple reminder to notice that this is just a thought.

You can thank your mind when a thought comes up. So saying “Thank you for protecting me, thank you for trying to protect me” – and not doing this in this very sarcastic way. Your mind genuinely is trying to protect you. This is why certain thoughts are coming up, and it believes that this is the best way to protect you. So being able to thank your mind and still not having to act on that thought.

Another one is naming the story. What often happens with so many of the thoughts that come up is, one, they’re very repeatable. There’s a lot of repetition with the thoughts that come up. But two, they can fit, often, into certain categories. There might be 10 different thoughts that all relate to fears around weight gain, or there could be 20 different thoughts and they all relate to fears around health and the healthfulness of food. So the goal here is we can put all of those different thoughts into that one category, and then any time I have one of those thoughts, it can be like, “Ah, I’m noticing my mind is generating the ‘I can’t trust my hunger’ story again” or “I’m noticing my mind is generating the ‘unhealthy food’ story again.”

Being able to frame it in that way, I instantly remember I don’t need to come up with a counterargument to this thought. I just have to recognise that it’s one of those thoughts. I think this is really important, because I think so often, people get stuck in the “I’ve got to come up with a better argument, I’ve got to be able to prove this thing is incorrect”, and you often get into this real arms race with the eating disorder where you’re each coming up with different thoughts and it doesn’t get particularly far.

For some people, it can be useful. For some people, doing some journalling on it, that actually does help. So it’s not that you can’t do it in that way. It’s just what I’ve noticed over the years is actually, most of the time when these things are staying in someone’s mind, there becomes a lot of rumination, and the longer I stay with this, I then get pulled in a certain direction towards engaging in eating disorder behaviours. So being able to create room between yourself and your thoughts through defusion is really helpful.

Part of the reason why this is really helpful is, as I said, so much of the stuff that’s coming up is repeatable, and it’s been repeated so many times that it can just sound like the truth, and you don’t even notice that this is actually a thought. It just sounds like this is the truth. So really, defusion is then a way to get that space so that you can see it as just a thought; you can recognise, “I don’t have to argue with it. I can just observe that it is here.”

00:16:35

Name the emotions or sensations

The next one is naming, being able to name certain sensations or certain emotions, and really getting into the details with this. I think so often, what happens is at the first sign of anything coming up, it’s “I’ve got to avoid this. I’ve got to get away from it. I’ve got to do some kind of behaviour to avoid this thing happening” as opposed to “How do I actually lean into this?” And not lean into this where I then get really swept away by all of these things, but how can I lean into this almost like a scientist or as an observer?

I talked about one of the principles of acceptance and commitment therapy of being that observer and being able to notice what is going on. So doing it in this way. Really giving language to often vague discomfort. So rather than just saying, “I’m noticing I’m feeling anxious”, you can then add in some descriptors connected to that. It could be “I’m noticing I feel tight” or “I feel buzzy” or “I feel wired” or “I feel trapped” and really being able to name the physical sensations or what those physical sensations feel like.

I think what often happens here – and this is counterintuitive with this – it feels like “If I start naming these things and really paying attention, then everything’s going to get so much worse and it’s going to feel even more overwhelming and even more engulfing.” And often what people notice is actually, by being able to name these things and being able to pay attention to all of the different subtleties with it, that presence actually starts to reduce the intensity of that. There can be more of a decrease in the fear connected to it because I’m now able to observe these things. The resistance to them starts to knock down.

I will just say with this, even though, as I said, the resistance can come down, it can feel less scary with it, it doesn’t mean that it’s going to get better immediately. It’s not that if I just start doing this, everything becomes better and they start to disappear. It just becomes less scary or less terrifying as you start to do this.

Something that is really helpful alongside this or as a way of doing this is Tara Brach’s RAIN meditation. I’ll put it in the show notes. Tara Brach has a wonderful podcast. She’s done a lot around mindfulness. There’s lots and lots of meditations she has as part of her podcast and online. There’s this thing called RAIN meditation, and RAIN is an acronym. It’s a way of going through some of these things and being able to label things and stay with them. I use this a lot with clients, and I would recommend checking this out.

I would say with this, if you’re someone who has really numbed for years, avoided for years, you can go slowly with this. Naming it isn’t a fix; it just makes you more of a witness to things. But you can go slowly with this.

00:19:50

Anchoring to values

The next piece is then anchoring or connecting to values and coming back to your values in the present moment. Again, when I’m working with clients, this is something we spend a lot of time on. We go through values, we figure out what someone’s true authentic values are, how they know when they’re living in alignment with those values, so they have descriptors of what it means for each of those values.

Being able to then come back to these in the present moment. So if something’s come up and I’m feeling some real intense feelings, whether that be about body image or a desire to restrict or a desire to exercise or whatever it may be connected to the eating disorder, being able to come back to what matters the most in this moment outside of the discomfort. Who am I becoming when I make these important and hard choices to recover? So being able to use those values.

To give an example, you’re eating a snack and it feels really scary to eat that snack, and “I feel like I want to pull back and I don’t want to do it.” You can then come back to your values, and your value may be spontaneity, or the value may be presence, or the value might be being a role model for my kids. So then using that as a way of saying, “I know this is hard, and the thing that I want to be is this other thing, and that’s why I’m going to keep doing it.”

Or it could be I need to rest, I know I need to rest, but it feels really hard to be able to rest. So I come back to my values, and one of my values is honesty. I no longer want to pretend that I’m okay, or I no longer want to pretend that I’m not exhausted. So because my value is honesty, I’m going to rest in this moment.

I think using the values piece, once we get clear on what someone’s values are, can be really helpful to cut through the noise of whatever is going on in that moment. And this can need a lot of prompting. Often what I’ll say when someone does create their values is, I want you to then be reading this on a daily basis to remind yourself of it. Because if you’re only trying to pull out your values and only ever think about them in those real peak emotional moments, it’s going to be really hard, versus if I’m reading my values on a very regular basis, I’m doing it every morning, it’s part of my daily routine, then when I’m entering into these kinds of moments, it’s going to be more likely that I’m going to come back to my values.

00:22:33

Acceptance

The next piece connected to this is acceptance. The thing I want to say with acceptance is this isn’t about liking or about approval. It’s about allowing. I think for a lot of people, there can also be this idea that acceptance means giving up or saying that it’s okay when it’s really not. What acceptance is about is really being in contact with the present moment and the reality of the situation. “This is here, this is what’s going on. I don’t necessarily like it, but I’m not going to fight against it.”

The thing with this is you can want to change without needing the discomfort to disappear first. I would say that that’s actually a prerequisite. If you’re wanting the discomfort to disappear first, whether that’s by doing some journalling or by working with a therapist or whatever it is, the reality is that it’s not going to disappear first. The way that discomfort disappears is by taking action and by going through and retraining the nervous system to relate to that situation in a different manner.

So really, with acceptance, I talk about acceptance being a verb. Acceptance is the ‘doing’ piece, and by doing it again and again, “Oh, I realised that I’m obviously accepting because I’ve been able to prove to myself that that’s happened.”

I think a couple of metaphors that can be useful connected to the acceptance piece is, one, the tug-of-war. Really, the more you pull, the stronger it fights back. So being able to just, in a lot of ways, surrender and say, “It is what it is.”

The other one would be thinking about sitting with a small child who is crying. The goal in that moment isn’t to fix; it’s just staying close to them and being able to offer comfort or to be able to help them settle. This is what acceptance is really about. It’s not about fixing. It’s about the willingness to be with the discomfort, with your discomfort, without abandoning yourself in that moment.

00:24:57

Body check-ins

The next one – and this is the final one I want to mention – is being able to do body check-ins. I know I talked earlier about being able to name emotions and being able to name different sensations connected to this. It’s being able to notice different body sensations. And you can do this in a number of different levels or working up to things.

One, it could be external grounding first. I’ve talked a little bit about some of these already – holding something that is warm or putting a blanket over yourself and noticing the sensations connected to that blanket or the weight connected to that blanket or putting the blanket between your fingers and feeling the sensations of that. It could be feeling your feet and rubbing your feet, or as I talked about, rubbing lotion into your hands. So there is that piece.

The next one is doing a body scan. You can do head to toe, you can do a certain part of your body, and just noticing what is coming up. Where do I notice tension? Where do I notice ease? Where do I notice things are warmer or things are cooler? There can be lots of different things that you can start to pay attention to as you go through this.

The next one – and this is, again, something that comes from acceptance and commitment therapy, and it’s called expansion. This is a practice where you first ground into the present moment; you then pay attention to your breath and the sensation of the breath that you notice, whether that be within your nose or your lungs or all of those different areas, and then doing a body scan where you find a particular sensation that you pay attention to. The goal with this is to then create room for that sensation that is there, not for it to go away, but for the resistance to it to start to loosen.

An exercise I’ll use a lot with clients is expansion because it allows someone to then stay in that present moment and be able to notice those sensations. This is just another way that we can use sensations and another way we can use body check-ins as part of staying in the present moment.

00:27:20

When are these techniques useful?

If I’m thinking about when these kinds of things could be useful – and this is just a few examples; it’s not an exhaustive list of different options – there could be the urge to restrict that comes up. It’s then sitting with that and not acting on it immediately. Or it could be letting yourself feel fullness. So “I’ve eaten a meal and there is fullness connected to this meal, and I’m not doing something to numb out or avoid that sensation. I’m able to sit with it.”

It could be saying yes to a particular plan, whether that’s going out and seeing friends who you haven’t seen for a while or having a dinner or having a meal or going to the pool. Doing something that really is pushing the boundary of what feels comfortable for you, and noticing that “I can say yes to these things, I can do these things, even though there is anxiety, or even though there are all these sensations that then come up.”

It could be noticing an increase in terms of body image struggles on a particular day or after a particular incident has happened or a trigger has happened.

In each of these different scenarios, it’s then using some of the different techniques that we’ve gone through as part of this episode. So using ways to then come back into the present moment, to use defusion to do with different thoughts or different sensations. It’s not about avoiding any of those things. And this is something I really want to get clear; the whole point of this isn’t so that I then check out and I don’t notice any of those things. It’s more that they can be there, and I can also be in this present moment, and that just because those things are there, doesn’t mean that I can’t take this action.

I think this is important because otherwise it can feel like “Well, I did that defusion exercise or I did that expansion exercise, and it didn’t leave me feeling better afterwards” or “Those thoughts were still there or those sensations were still there.” The goal isn’t to remove them. The goal is to be able to create enough room so that they’re able to be there and you’re still able to take the action that you need.

00:29:38

Final thoughts

The final thoughts I want to leave you with is that presence is not about peace at first. It really is about how to stay connected with your life and what is going on in terms of the experience. Each moment that you stay with the presence, even if it’s just for a little while, you’re teaching your nervous system that it’s okay to be here, that you can tolerate this, that you can be with this.

This is so much of the work that I do with people. There are these beliefs that “I can’t do this, this is too much, it’s too hard”, and them being able to realise, “Actually, that’s just not true. I am able to tolerate this. And a lot of that is because I actually did do the experience.” Often people don’t even get a chance to do the experience because of all of the ‘what if’ thinking and all the fears connected to that. They don’t even get a chance to test out “What actually happens when I put myself in that scenario?”

So what I’m wanting to have happen is, one, that people do the things that allow them to have that experience, and then two, we’re able to manage that by doing different things to help someone stay in the present and to help it be as positive an experience as possible.

The final piece is that there isn’t a perfect way of doing this. It’s going to be messy or wobbly or whatever the descriptor is, and really, that’s the point of it. That’s where the freedom lies. It’s “Hey, I was able to have this meal, and it felt like it was a bit of a disaster while it was going on and I still continued on doing it.” Or “I was able to meet these friends and it felt like it was hard for me to be present, but I kept coming back to it. There’d be times where I felt like I was checking out a little bit more, and I then would come back into the moment.” Just noticing that “In the past, I wouldn’t have been able to do that, and now I can.”

So it’s not that “I did this thing the first time and it went so, so well.” It’s “I did this thing, and I came back to it again and again, and with time, I’ve built up the skills and the wherewithal and the belief that I can actually be with these feelings and sensations and thoughts.”

So, that is it for this week’s episode. I hope that you don’t just listen to this one and then move on, but you listen to this one and then pick one of the tools that I went through and say, “I’m going to commit, over the next week or the next two weeks, to actually use that. I’m going to sit down and do the RAIN meditation as things come up, or I’m going to do the expansion exercise, or I’m going to do the 5-4-3-2-1 exercise where I’m bringing in more of my senses as part of this.”

The whole point of recovery and what actually makes a difference is action-taking, so I don’t want this to just be an exercise in you listening and thinking, “Oh, that sounds good” or “That’s some good advice” and then not actually implementing it. Pick one of the tools and try it out, and I would love to hear how you get on.

So that is it for this week’s episode. As I mentioned at the top, I’m currently taking on new clients. If you would like to reach a place of full recovery, I would love to help you get there. This is just a tiny example of some of the things that I work on with clients. So if you want to reach that place of full recovery, please send an email to info@seven-health.com and just put ‘coaching’ in the subject line and I will send over the details.

Alright, until then, or until next week, I will catch you then. Take care!

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